Dust, Surface Mold or Particle Single-Sample Chain of Custody Form & Mailing Instructions
Type-into and print this PDF form to send a single sample to an environmental testing lab - © 1986-2010 Daniel Friedman
Environmental Testing, Paint Analysis, Art Conservation, Forensic Particle Identification, Indoor Air Investigations, Bioaerosols, Pollen, Mold, Mildew, Moisture. Mold Sampling & Laboratory Analysis

Mail to: MAIL TO: [Mail this form with your sample to an environmental test lab of your choice. Please do not send your sample to us without prior agreement.]




Six Easy Steps to Get and Mail a Mold Test Kit            - http://InspectAPedia.com/sickhouse/Adhesive_Tape_Particle_Test.php
Printer-friendly Multi-Sample Chain of Custody Form      - http://inspectapedia.com/sickhouse/MoldSampleChainofCustody.pdf
Printer Friendly Mold, Dust, or Particle Sample Mailing  - http://inspectapedia.com/sickhouse/Sample_Mailing_Instructions.pdf

FORENSIC LAB SAMPLE PROCESSING AVAILABILITY NOTICE: We are not accepting test samples at our lab except in limited pro-bono cases by prearrangement. We apologize for the inconvenience. The procedure described at TEST KITS for DUST, MOLD, PARTICLE TESTS for tape sampling produces high quality surface samples of building dust, particle samples, mold or mold-suspect material, or other particles for identification by a qualified laboratory. We will continue to be available for email or emergency consultation described at Contact Us - use the CONTACT email found at InspectApedia.com

Mailing Address
Telephone (1)
Email (2)
Sampling Address

The identity and address of the building or location from which the samples were collected.

Sampling Area Descriptions

A general description of the building conditions such as evidence of visible mold, leak history, other comments.

Sample Description

More than one sample? use our Chain of Custody Form to number, identify, & describe

Signature &
Sample Collection
Date / Time
Sign: Collection Time & Date

Your check for the lab fee. Lab Fee Schedule and Payment Instructions are below.
_ Payment by PayPal - http://inspectapedia.com/sickhouse/Adhesive_Tape_Particle_Test.php#PayTo
_ Payment by pesonal check or money order payable to Daniel Friedman

  1. Your telephone number for voice contact in the event that we need to call you.
  2. Your email address to receive an emailed-copy of your report. We also mail a printed copy to the mailing address you provide.
    As you'll see at our LAB FEE SCHEDULE, the lab fee per individual tape samples of mold or particles is $50. each.
    Add $15. to your fee and a telephone fax number if you also need your report to be faxed to a telephone number.

PLEASE DO NOT REQUIRE A RECEIPT SIGNATURE on packages sent to the lab. Failure to follow this suggestion will delay
processing of your sample or may result in the sample being returned to you without processing. If you are using the U.S. Post Office's
Express Mail be sure to check and sign the signature waiver box on the mailing label.

07/20/2015 - 05/22/1988 - InspectAPedia.com/sickhouse/Sample_Mailing_Instructions.htm & sickhouse/Sample_Mailing_Instructions.htm - © 2011 - 1988 Copyright Daniel Friedman All Rights Reserved